Madison Medical Center

All Charges

Charge

Type

Setting

Price

MCGRAW GLUCOSE - FINGER STICK

Facility

$30.00

Service Code	CPT 82962
Hospital Charge Code	4282962
Hospital Revenue Code	301
Rate for Payer: Cash Price	$27.00

MCGRAW GLUCOSE - FINGER STICK

Facility

$30.00

Service Code	CPT 82962
Hospital Charge Code	4282962
Hospital Revenue Code	301
Min. Negotiated Rate	$2.95
Max. Negotiated Rate	$21.42
Rate for Payer: Aetna Better Health Medicaid/QHP	$2.95
Rate for Payer: Aetna Medicare Advantage	$3.28
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$17.76
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$21.42
Rate for Payer: Cash Price	$27.00
Rate for Payer: Cash Price	$27.00
Rate for Payer: Cash Price	$27.00
Rate for Payer: Cigna Commercial HMO & PPO	$3.28
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$2.95
Rate for Payer: Home State Health Plan Medicaid Managed Care	$3.16
Rate for Payer: Home State Health Plan Medicare Advantage	$3.28
Rate for Payer: Humana Commercial	$6.56
Rate for Payer: Humana Medicare Advantage	$3.28
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$2.95
Rate for Payer: UnitedHealthcare Medicare Advantage	$10.80

MCGRAW INFLUENZA A&B TEST

Facility

$123.00

Service Code	CPT 87502
Hospital Charge Code	4287502
Hospital Revenue Code	301
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$191.60
Rate for Payer: Aetna Better Health Medicaid/QHP	$86.22
Rate for Payer: Aetna Medicare Advantage	$95.80
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$72.82
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$87.82
Rate for Payer: Cash Price	$110.70
Rate for Payer: Cash Price	$110.70
Rate for Payer: Cash Price	$110.70
Rate for Payer: Cigna Commercial HMO & PPO	$95.80
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$86.22
Rate for Payer: Home State Health Plan Medicaid Managed Care	$92.26
Rate for Payer: Home State Health Plan Medicare Advantage	$95.80
Rate for Payer: Humana Commercial	$191.60
Rate for Payer: Humana Medicare Advantage	$95.80
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$86.22
Rate for Payer: UnitedHealthcare Medicare Advantage	$44.28

MCGRAW INFLUENZA A&B TEST

Facility

$123.00

Service Code	CPT 87502
Hospital Charge Code	4287502
Hospital Revenue Code	301
Rate for Payer: Cash Price	$110.70

MCGRAW RSV

Facility

$123.00

Service Code	CPT 87634
Hospital Charge Code	4287634
Hospital Revenue Code	301
Rate for Payer: Cash Price	$110.70

MCGRAW RSV

Facility

$123.00

Service Code	CPT 87634
Hospital Charge Code	4287634
Hospital Revenue Code	301
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$140.40
Rate for Payer: Aetna Better Health Medicaid/QHP	$63.18
Rate for Payer: Aetna Medicare Advantage	$70.20
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$72.82
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$87.82
Rate for Payer: Cash Price	$110.70
Rate for Payer: Cash Price	$110.70
Rate for Payer: Cash Price	$110.70
Rate for Payer: Cigna Commercial HMO & PPO	$70.20
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$63.18
Rate for Payer: Home State Health Plan Medicaid Managed Care	$67.60
Rate for Payer: Home State Health Plan Medicare Advantage	$70.20
Rate for Payer: Humana Commercial	$140.40
Rate for Payer: Humana Medicare Advantage	$70.20
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$63.18
Rate for Payer: UnitedHealthcare Medicare Advantage	$44.28

MCGRAW STREP

Facility

$75.00

Service Code	CPT 87651
Hospital Charge Code	4287651
Hospital Revenue Code	301
Rate for Payer: Cash Price	$67.50

MCGRAW STREP

Facility

$75.00

Service Code	CPT 87651
Hospital Charge Code	4287651
Hospital Revenue Code	301
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$70.18
Rate for Payer: Aetna Better Health Medicaid/QHP	$31.58
Rate for Payer: Aetna Medicare Advantage	$35.09
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$44.40
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$53.55
Rate for Payer: Cash Price	$67.50
Rate for Payer: Cash Price	$67.50
Rate for Payer: Cash Price	$67.50
Rate for Payer: Cigna Commercial HMO & PPO	$35.09
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$31.58
Rate for Payer: Home State Health Plan Medicaid Managed Care	$33.79
Rate for Payer: Home State Health Plan Medicare Advantage	$35.09
Rate for Payer: Humana Commercial	$70.18
Rate for Payer: Humana Medicare Advantage	$35.09
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$31.58
Rate for Payer: UnitedHealthcare Medicare Advantage	$27.00

MDI INITIAL

Facility

$165.00

Service Code	CPT 94640
Hospital Charge Code	4594640
Hospital Revenue Code	412
Rate for Payer: Cash Price	$148.50

MDI INITIAL

Facility

$165.00

Service Code	CPT 94640
Hospital Charge Code	4594640
Hospital Revenue Code	412
Min. Negotiated Rate	$59.40
Max. Negotiated Rate	$447.44
Rate for Payer: Aetna Better Health Medicaid/QHP	$197.40
Rate for Payer: Aetna Medicare Advantage	$223.72
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$97.68
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$117.81
Rate for Payer: Cash Price	$148.50
Rate for Payer: Cash Price	$148.50
Rate for Payer: Cash Price	$148.50
Rate for Payer: Cigna Commercial HMO & PPO	$223.72
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$197.40
Rate for Payer: Home State Health Plan Medicaid Managed Care	$211.22
Rate for Payer: Home State Health Plan Medicare Advantage	$223.72
Rate for Payer: Humana Commercial	$447.44
Rate for Payer: Humana Medicare Advantage	$223.72
Rate for Payer: UnitedHealthcare Commercial	$110.06
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$197.40
Rate for Payer: UnitedHealthcare Medicare Advantage	$59.40

MDI SUBSEQUENT

Facility

$165.00

Service Code	CPT 94640
Hospital Charge Code	4594641
Hospital Revenue Code	412
Min. Negotiated Rate	$59.40
Max. Negotiated Rate	$447.44
Rate for Payer: Aetna Better Health Medicaid/QHP	$197.40
Rate for Payer: Aetna Medicare Advantage	$223.72
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$97.68
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$117.81
Rate for Payer: Cash Price	$148.50
Rate for Payer: Cash Price	$148.50
Rate for Payer: Cash Price	$148.50
Rate for Payer: Cigna Commercial HMO & PPO	$223.72
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$197.40
Rate for Payer: Home State Health Plan Medicaid Managed Care	$211.22
Rate for Payer: Home State Health Plan Medicare Advantage	$223.72
Rate for Payer: Humana Commercial	$447.44
Rate for Payer: Humana Medicare Advantage	$223.72
Rate for Payer: UnitedHealthcare Commercial	$110.06
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$197.40
Rate for Payer: UnitedHealthcare Medicare Advantage	$59.40

MDI SUBSEQUENT

Facility

$165.00

Service Code	CPT 94640
Hospital Charge Code	4594641
Hospital Revenue Code	412
Rate for Payer: Cash Price	$148.50

MEASLES (RUBEOLA), PCR, Swab

Facility

$571.00

Service Code	CPT 87798
Hospital Charge Code	2287795
Hospital Revenue Code	301
Rate for Payer: Cash Price	$513.90

MEASLES (RUBEOLA), PCR, Swab

Facility

$571.00

Service Code	CPT 87798
Hospital Charge Code	2287795
Hospital Revenue Code	301
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$407.69
Rate for Payer: Aetna Better Health Medicaid/QHP	$31.58
Rate for Payer: Aetna Medicare Advantage	$35.09
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$338.03
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$407.69
Rate for Payer: Cash Price	$513.90
Rate for Payer: Cash Price	$513.90
Rate for Payer: Cash Price	$513.90
Rate for Payer: Cigna Commercial HMO & PPO	$35.09
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$31.58
Rate for Payer: Home State Health Plan Medicaid Managed Care	$33.79
Rate for Payer: Home State Health Plan Medicare Advantage	$35.09
Rate for Payer: Humana Commercial	$70.18
Rate for Payer: Humana Medicare Advantage	$35.09
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$31.58
Rate for Payer: UnitedHealthcare Medicare Advantage	$205.56

MEATOTOMY, EXCEPT INFANT

Professional

Both

$446.00

Service Code	CPT 53020
Hospital Charge Code	5453020
Hospital Revenue Code	975
Min. Negotiated Rate	$71.81
Max. Negotiated Rate	$156.10
Rate for Payer: Aetna Commercial/Medicare Advantage	$83.04
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$71.81
Rate for Payer: Cash Price	$401.40
Rate for Payer: Cash Price	$401.40
Rate for Payer: Cigna Commercial HMO & PPO	$83.04
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$71.81
Rate for Payer: Home State Health Plan Medicaid Managed Care	$78.99
Rate for Payer: Home State Health Plan Medicare Advantage	$83.04
Rate for Payer: Optum Medicare Advantage	$156.10
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$71.81

MECLIZINE (ANTIVERT) 12.5MG TAB

Facility

$20.00

Service Code	NDC 4.2806E+10
Hospital Charge Code	2655465
Hospital Revenue Code	250
Rate for Payer: Cash Price	$18.00

MECLIZINE (ANTIVERT) 12.5MG TAB

Facility

$20.00

Service Code	NDC 4.2806E+10
Hospital Charge Code	2655465
Hospital Revenue Code	250
Min. Negotiated Rate	$7.20
Max. Negotiated Rate	$14.28
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$11.84
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$14.28
Rate for Payer: Cash Price	$18.00
Rate for Payer: UnitedHealthcare Commercial	$13.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.20

MECLIZINE (ANTIVERT) 25MG TAB EMP

Facility

$20.00

Service Code	NDC 6.9618E+10
Hospital Charge Code	2622118
Hospital Revenue Code	250
Rate for Payer: Cash Price	$18.00

MECLIZINE (ANTIVERT) 25MG TAB EMP

Facility

$20.00

Service Code	NDC 6.9618E+10
Hospital Charge Code	2622118
Hospital Revenue Code	250
Min. Negotiated Rate	$7.20
Max. Negotiated Rate	$14.28
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$11.84
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$14.28
Rate for Payer: Cash Price	$18.00
Rate for Payer: UnitedHealthcare Commercial	$13.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.20

MEDICAL BACK PROBLEMS WITH MCC

Facility

$29,896.78

Service Code	MSDRG 551
Min. Negotiated Rate	$14,948.39
Max. Negotiated Rate	$29,896.78
Rate for Payer: Aetna Medicare Advantage	$14,948.39
Rate for Payer: Cigna Commercial HMO & PPO	$14,948.39
Rate for Payer: Home State Health Plan Medicare Advantage	$14,948.39
Rate for Payer: Humana Commercial	$29,896.78
Rate for Payer: Humana Medicare Advantage	$14,948.39

MEDICAL BACK PROBLEMS WITHOUT MCC

Facility

$18,688.26

Service Code	MSDRG 552
Min. Negotiated Rate	$9,344.13
Max. Negotiated Rate	$18,688.26
Rate for Payer: Aetna Medicare Advantage	$9,344.13
Rate for Payer: Cigna Commercial HMO & PPO	$9,344.13
Rate for Payer: Home State Health Plan Medicare Advantage	$9,344.13
Rate for Payer: Humana Commercial	$18,688.26
Rate for Payer: Humana Medicare Advantage	$9,344.13

MEDICARE CERVICAL/VAGINAL EXAMINATION

Facility

$66.00

Service Code	CPT G0101
Hospital Charge Code	4100101
Hospital Revenue Code	521
Rate for Payer: Cash Price	$59.40

MEDICARE CERVICAL/VAGINAL EXAMINATION

Facility

$66.00

Service Code	CPT G0101
Hospital Charge Code	4100101
Hospital Revenue Code	521
Min. Negotiated Rate	$39.07
Max. Negotiated Rate	$207.58
Rate for Payer: Aetna Medicare Advantage	$103.79
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$39.07
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$47.12
Rate for Payer: Cash Price	$59.40
Rate for Payer: Cash Price	$59.40
Rate for Payer: Cash Price	$59.40
Rate for Payer: Cigna Commercial HMO & PPO	$103.79
Rate for Payer: Home State Health Plan Medicare Advantage	$103.79
Rate for Payer: Humana Commercial	$207.58
Rate for Payer: Humana Medicare Advantage	$103.79
Rate for Payer: UnitedHealthcare Commercial	$44.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

MEDICARE SCREENING PAP SMEAR

Facility

$32.00

Service Code	CPT Q0091
Hospital Charge Code	4100091
Hospital Revenue Code	521
Min. Negotiated Rate	$18.94
Max. Negotiated Rate	$173.53
Rate for Payer: Aetna Medicare Advantage	$29.55
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$18.94
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$22.85
Rate for Payer: Cash Price	$28.80
Rate for Payer: Cash Price	$28.80
Rate for Payer: Cash Price	$28.80
Rate for Payer: Cigna Commercial HMO & PPO	$29.55
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$23.46
Rate for Payer: Home State Health Plan Medicare Advantage	$29.55
Rate for Payer: Humana Commercial	$59.10
Rate for Payer: Humana Medicare Advantage	$29.55
Rate for Payer: UnitedHealthcare Commercial	$21.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

MEDICARE SCREENING PAP SMEAR

Facility

$32.00

Service Code	CPT Q0091
Hospital Charge Code	4100091
Hospital Revenue Code	521
Rate for Payer: Cash Price	$28.80

Know your out-of-pocket cost for care.

All Charges